Multiple Brown Tumor as Manifestation of Parathyroid Hyperplasia with End-stage Renal Failure: A Case Report

棕色瘤主要由原發性或少部分由續發於二或三度之副甲狀腺亢進症所引起之代償性細胞增生，可導致骨骼增生，臨床上極少見，易被誤為轉移性骨骼腫瘤。我們介紹一個尿毒症引發續發性副甲狀腺亢進導致棕色瘤增生，起初被骨科醫師懷疑為骨癌，經內科以其病史高度懷疑為副甲狀腺腫瘤，經病理切片鑑別診斷，並以手術切除副甲狀腺腫瘤來治療。透析治療盛行後，此種慢性腎衰竭併發症已經少見，茲提出此案，以供醫界參考並分享我們的經驗，並藉此隨時提高警覺與鑑別診斷。

關鍵字

尿毒症；副甲狀腺亢進；棕色瘤

並列摘要

Brown tumor is a cellular process of reparative proliferation caused by primary or, less commonly, secondary or tertiary hyperparathyroidism (HPT). Multiple skeletal involvement is exceedingly rare and may be mistaken for a clinical impression of metastatic lesion. We describe a case involving an uremic woman who had suffered from multiple brown tumors complicated with secondary HPT due to years of uncontrolled renal failure. The radiographic findings showed a picture similar to metastatic carcinoma of bone. Bone biopsy of a rib was performed and histopathologic studies revealed small fragments of regenerative bone tissue surrounded by a benign spindle cell proliferation containing osteoclastic multinucleated giant cells. The biochemical laboratory investigations showed marked elevation of intact parathyroid hormone. Regular hemodialysis and parathyroidectomy were performed. In secondary HPT, which is primarily caused by chronic renal failure, the incidence of brown tumor is 1.5 to 1.7%, and is now rare because of improved dialysis therapy for uremic patients. There is a paucity of reports describing the atypical locations of brown tumors involving the orbit, the maxillofacial bones, and the ribs, as was observed in our patient. We present this case to share our experience, and to alert physicians to keep this disease in mind.

並列關鍵字

uremia ； brown tumor ； hyperparathyroidism

國際替代計量

Multiple Brown Tumor as Manifestation of Parathyroid Hyperplasia with End-stage Renal Failure: A Case Report

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